Surviving the Stresses of Clinical Oncology by Improving Communication

Surviving the Stresses of Clinical Oncology by Improving Communication

In their article, Armstrong and Holland
briefly review many of the
reasons why the practice of oncology
is likely to be stressful, including
the factors that lead to burnout
or feelings of being overwhelmed.
The article then goes on to focus on
ways to enhance communication in
the clinical setting as an important approach to dealing with the stress of
clinical practice and the symptoms of
burnout. The scenarios described are
familiar, and the authors do a good job
highlighting the challenges of these situations
by providing examples of strategies
that can enhance communication
and potentially reduce distress.
Limits of Effective Communication
Effective communication may assist
the patient and the doctor through
difficult moments in their relationship;
however, it may do little to reduce
the stress that is unavoidable
and integral to taking care of seriously
ill people. Unfortunately, just the
wear and tear of repeatedly communicating
bad news or even communicating
relatively good news about a
favorable prognosis, can become emotionally
draining. In specialized practices
that focus on patients who are
almost always seriously ill (eg, pancreatic
cancer, metastatic lung cancer),
the need to distance and depersonalize
may, at times, be a necessary
coping strategy, just to get through
the day.
The examples and suggestions provided
by the authors will be valuable
to the less experienced oncologist or
to those who may lack insight into the
psychosocial issues associated with
these common situations; however,
experienced oncologists who have
mastered these communication techniques
may need additional strategies
to help them address the daily stresses
of practice. There is a need for better
therapies-treatment oriented and
supportive-in the armamentarium
when initial treatments do not work.
Patients and the public need to be
educated to have realistic expectations
about the limitations of medical care
and the important role of palliative
care as part of cancer management.
No matter how effective we are in
communicating bad news, we will feel
the pain, suffering, and emotional distress
of our patients and their families.
It is simplistic to think that
effective communication will eliminate
those feelings.
The Team Approach
What would have been helpful to
readers is a description of models of
care in oncology settings that have been
successful in diffusing the stress associated
with the delivery of bad news
and the challenges of coordinating
care. What models are in place at Memorial
Sloan-Kettering or other cancer
centers? How have experienced
oncologists organized their practices
to help them cope with the stresses
mentioned in the article? Some examples
that come to mind include multidisciplinary
breast centers, where care
is provided by a team of oncology
clinicians (surgeons, radiation and
medical oncologists, nurses) and other
support staff (social workers, psychologists,
physical therapists). In this
way, the patient's educational, psychological,
and medical needs are comprehensively met, and one clinician
is not responsible for addressing
all of the patient's needs.
In the treatment of childhood cancer,
this type of coordinated and family-
centered care is standard at most
treatment referral centers. In many
clinical oncology practices, astute clinicians
have incorporated social support
services or physician extenders
(nurse practitioners, physician assistants)
into their practice, as a way to
effectively manage the delivery of
care, so that it does not fall on only
one oncology clinician's shoulders.
Using a team approach in the care of
oncology patients also means that all
of those involved can share the burden
by communicating with each other
about specific challenges as well as
accomplishments (eg, managing a
good death). This can provide important
support and buffering in everyday
practice and may be a critical
component of clinical practices with
low burnout rates and good morale.
Transitions in Cancer Care
It would also be interesting to know
how many oncologists can maintain a
full-time clinical practice across the
span of a career. My own observations
in both academic and clinical
settings suggest that often there is a
transition from full-time practice to
more limited involvement in clinical
care after about 2 decades (eg, administrative
leadership positions in a
clinical setting, running clinical trials,
or limited practice as an academic
clinician). These transitions may reflect
the natural professional evolution
of midcareer physicians or could
be related to the difficulties in sustaining
a clinical practice with seriously
ill patients over a career in
medicine.
Understanding workforce patterns
in oncology, as well as effective organizational
strategies for the delivery of
oncology care, could go a long way
toward ensuring that we will have an
adequate and skilled cadre of oncology
clinicians now and in the future.
This will be increasingly important
with the aging of the population and
the broadening involvement of oncologists
in the prevention and treatment
of cancer.

Disclosures

The author(s) have no significant financial interest or other relationship with the manufacturers of any products or providers of any service mentioned in this article.

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